Immune-Related Adverse Events and Corticosteroid Use for Cancer-Related Symptoms Are Associated With Efficacy in Patients With Non-small Cell Lung Cancer Receiving Anti-PD-(L)1 Blockade Agents
Por:
Riudavets, M, Mosquera, J, Garcia-Campelo, R, Serra, J, Anguera, G, Gallardo, P, Sullivan, I, Barba, A, del Carpio, L, Barnadas, A, Gich, I, Majem, M
Publicada:
7 sep 2020
Resumen:
Background:Immune-related adverse events (irAEs) have been associated with improved efficacy in advanced non-small cell lung cancer (NSCLC) patients receiving anti-PD-(L)1 blockade agents, while the concurrent use of corticosteroids seems to worsen it. We evaluated outcomes in advanced NSCLC patients treated with anti-PD-(L)1 blockade agents in relation to the presence of irAEs and the reasons for using corticosteroids: whether for palliative cancer-related reasons or for the management of irAEs. Methods:Clinical outcomes in advanced NSCLC patients treated with anti-PD-(L)1 blockade agents were calculated with regard to the presence of irAEs and the use of corticosteroids. A landmark analysis was performed to avoid immortal time bias due to the time-dependent nature of irAEs. Results:Out of a total of 267 patients, the 56.9% of patients who experienced irAEs had significantly improved outcomes. In the landmark analysis, median progression-free survival (PFS) was 12.4 months for patients with irAEs vs. 4.1 months for patients without irAEs (p< 0.001), while median overall survival (OS) was 28.2 vs. 12.5 months, respectively (p< 0.001). Likewise, objective response and disease control rates were significantly higher in patients experiencing irAEs: 48.6 vs. 22.8% and 77.1 vs. 39.6% (p< 0.001), respectively. Median OS was significantly shorter for patients receiving >= 10 mg of prednisone equivalent daily for cancer-related symptoms than for the rest of patients (<10 mg prednisone equivalent daily or for management of irAEs): 6 vs. 15.9 months (p< 0.001). Conclusions:IrAEs were associated with improved efficacy in advanced NSCLC patients when a landmark analysis was applied. Patients receiving corticosteroids had significantly poorer outcomes when they were used for cancer-related symptoms.
Filiaciones:
Riudavets, M:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Univ Autonoma Barcelona UAB, Dept Med, Barcelona, Spain
Mosquera, J:
Hosp Univ A Coruna, Dept Med Oncol, La Coruna, Spain
Garcia-Campelo, R:
Hosp Univ A Coruna, Dept Med Oncol, La Coruna, Spain
Serra, J:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Anguera, G:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Gallardo, P:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Sullivan, I:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Barba, A:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
del Carpio, L:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Barnadas, A:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Gich, I:
Hosp Santa Creu & Sant Pau, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain
St Pau Biomed Res Inst IIB St Pau, Barcelona, Spain
Majem, M:
Hosp Santa Creu & Sant Pau, Dept Med Oncol, Barcelona, Spain
Gold, Green Published
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